Surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion.Methods From January 2010 to November 2015,307 patients of acute Stanford A aortic dissection underwent operation were included.The mean age was (51.3 ± 13.0) years,ranged from 22 to 83.The BMI was (25.4 ± 3.7) kg/m2 and 239 (77.9％) were men.There were 210 (71.2％) with hypertension,9 (2.9％) with Marian syndrome,and 44 (14.3％) with cardiac tamponade.Coronary malperfusion was confirmed in 43(14.0％) patients with 34 in right coronary artery,5 in left coronary artery,and 4 in both.There were 26 type A,8 type B,9 type C in Neri system.We performed coronary ostia repair in 12 patients,Bentall in 16,coronary artery bypass grafting(CABG) in 9,and Bentall plus CABG in 6.CABG was also performed in 1 Bentall,1 aortic valve repair,and 5 ascending aorta replacement in 264 patients without coronary malperfusion.Results The rate of CABG,cardiopulmonary bypass(CPB) time,aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P ＜0.01).The in-hospital mortality was 32.6％ in patients with coronary malperfusion and 14.4％ in patients without coronary malperfusion.Thus,coronary malperfusion significantly increased in-hospital mortality(P ＜0.01).The mean follow-up time was(19.2 ± 18.0) months with a 95％ follow-up rate.The total follow-up survival rate is 97.5％ and the rate of patients with coronary malperfusion is 100％.Multivariate logistic regression analysis shows that cardiac tamponade(OR =4.8,P ＜0.01) and CPB time(OR =1.0,P ＜0.01) was the independent risk factor of post-operation inhospital mortality of acute Stanford A aortic dissection.Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly.The treatment strategy depends on the specific clinical condition.